Influenza Vaccination of Healthcare Workers

Healthcare workers (HCWs) being vaccinated against influenza is an important general infection control practice. It is recommended by the Centers for Disease Control and Prevention (CDC) that all HCWs be vaccinated against influenza annually.1-3 According to the CDC, in the 2005-2006 flu season, only 42 percent of surveyed HCWs received a flu vaccination.4 It is important for hospitals to develop a comprehensive employee influenza campaign in order to decrease the transmission of the flu virus. In hospitals where less than 42 percent of HCWs consent to influenza vaccination, there is a greater challenge. This was the case at my facility, North General Hospital, and its employee influenza vaccination techniques were updated. A review of North General influenza campaigns in 2007 and 2008 showed a marked increase in screening and vaccination rates when employee education and roving clinics were implemented.

In previous influenza campaigns, the employees of North General would either receive flu vaccination at Employee Health Services or through their private clinicians. Without a focused influenza campaign, the screening and vaccination rates lagged at 15 percent and 9 percent, respectively, in 2006. There was no confidence in the influenza vaccine among HCWs. There was also the problem of the many myths and misconceptions regarding the flu vaccine. Following a guideline by the National Foundation for Infectious Diseases,5 the influenza campaign at North General was revamped. Employee Health Services focused on making the influenza vaccine mobile through the use of roving clinics and focused on education to dispel vaccination myths.

Up to 25 percent of unimmunized HCWs develop influenza during the winter.6 HCWs are exposed to the viruses of the general community via household contacts and public transportation and in the workplace via patients, co-workers, and visitors. This increase in exposure more than the general public, increases the risk of the HCW developing and transmitting influenza. It is also common practice for HCWs to continue working while they are ill. The nursing shortage and lack of coverage for sick employees can be attributed to this practice. The influenza virus can be transmitted from the day before symptoms appear up until a week later. A non-immunized HCW feeling “under the weather” but not sick enough to stay home can transmit the virus to their patients, their co-workers and any others they come into contact with. This can bring about serious influenza-related illnesses and complications in young children, adults older than 65 years, and our immunocompromised patients.

Education and reeducation of our staff is necessary to the success of a hospital’s influenza campaign. It is not enough just to dispel the myths of flu vaccination once. It has to be a continuous process that is echoed through our nursing supervisors, employee health clinicians, attending physicians and top management. Education, through the use of grand rounds meetings, posters and literature prove to be the easiest and most direct way of reaching HCWs. North General hosted two nursing grand rounds with representatives from the health department presenting topics on influenza vaccination and pandemic flu in 2006. The grand rounds were open not only to our nursing staff, but to our residents and attending physicians. Using the grand round approach to begin an influenza campaign can get staff motivated to start promoting influenza vaccination to their fellow co-workers and to their patients.

Continuing the education throughout the length of the campaign is also vital. Posters about influenza vaccination are distributed hospital wide in the early fall and newsletters are transmitted via email. Roving clinic sites are scheduled and departmental managers are contacted. During the campaign, education continues with biweekly newsletters and public announcements of areas of flu distribution. A whole month is dedicated toward the influenza campaign. Educate, reeducate and educate even more. Vaccination rumors, such as the vaccine causing influenza and HCWs not being at risk, need to be consistently replaced with flu vaccination truths.

The use of declination statements during an influenza campaign is a good tool that can provide information on why workers are not being vaccinated that can be used in future campaigns. It is important to know why HCWs are refusing influenza vaccination, so that these reasons can be addressed. HCWs at North General were refusing flu vaccination because they received the vaccine from their primary care physician, they do not usually get the flu, and they were afraid of a bad reaction.

With the cost of healthcare on the rise, paying a co pay and an additional fee for a flu vaccine can be an economic burden. By starting an influenza campaign early, and offering the vaccine at no cost, most employees who would regularly get the vaccine from their physicians opt to get it done at the workplace. In the 2007 and 2008 influenza campaigns the focus was on offering the vaccine as soon as it was received and emphasizing that the vaccine was free.

Making the influenza vaccine accessible to employees increases vaccination rates. Bringing the influenza vaccine to the employee’s worksite is convenient for the worker and gives the opportunity to convince others to receive the vaccine. It is not enough these days to just have the vaccine available at Employee Health Services. Not all HCWs are able to leave their workstations for more than a few minutes. Mobile clinics yielded the highest number of employee response when compared to other modes of vaccine delivery.

Roving clinics also need to be tailored to the various shifts that HCWs work. Just going to a department once will not capture the majority of the employees that work on that unit. In the 2008 influenza campaign, North General used multiple roving clinics within the nursing department at various times in order to capture the greatest number of workers. Also, having other roving clinics in the ambulatory and emergency medicine departments ensure adequate coverage of nursing employees in all regions of the hospital. Having these vaccination clinics run concurrently also will increase screening and vaccination rates. An increase in roving clinics in 2008, yielded an increase in screening and vaccination rates by 44 percent and 20 percent, respectively.

The combination of education and roving flu vaccine clinics are key to the success of a hospital’s influenza campaign. Dispelling the myths of vaccination can increase awareness of the benefits of receiving the flu vaccine. Education also allows for communication between co-workers to encourage each other to consent to vaccination. Making the vaccine as convenient as possible also increases vaccination rates and is greatly appreciated by staff that cannot physically leave their workplaces. North General’s transition to a more roving clinic based influenza campaign has continuously showed increase in its screening and vaccination rates. In 2008, 84 percent of influenza vaccines were distributed at sites other than the Employee Health Services office. Having a designated influenza vaccine campaign person to oversee all roving clinics and collect data for analysis, is also a necessary component. Past campaigns should be reviewed and corrections made prior to the next year’s campaign. Input from the staff is also important to ensure that roving clinics are serving their purpose.

A comprehensive influenza vaccination program is important in order to increase vaccination rates among HCWs. Education from occupational health clinicians is vital to the success of any flu vaccine campaign. When utilized correctly, roving flu clinics can increase screening and vaccination rates. Most importantly, once HCWs understand their role in the transmission of the flu virus, then our influenza vaccination campaigns can truly be effective. Influenza can be a deadly disease to the very young, immunocompromised and elderly population and we, as HCWs, need to practice prevention.

Linda Primus is a physician assistant and manager of employee health services at North General Hospital in New York City. She has been a PA for the past 10 years and a manager of employee health services for the past two and a half years. She also works in internal medicine at Montefiore Medical Center in the Bronx, New York. She received her bachelor’s degree in physician assistant studies from the Sophie Davis School of Biomedical Education Physician Assistant Program at Harlem Hospital, and her master’s degree in biology from New York University.

References:

1. Bolyard EA, Tablan OC, Williams WW, Pearson ML, Shapiro CN, Deitchmann SD. Guidline for infection control in healthcare personnel, 1998. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidem. 1998;19(6):407-63.

2. CDC. Prevention and control of influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP), MMWR. 2003;52(RR-8):1-34.

3. CDC. Prevention and control of influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Hospital Infection Control Practices Advisory Committee. MMWR.1997;46(RR-18):1-45.

4. CDC. Prevention and control of influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP), MMWR. 2008;57:1-60.

5. National Foundation for Infectious Diseases, Bethesda, MD. Improving Influenza Vaccination Rates in Health Care Workers; strategies to increase protection for workers and patients, 2004; 1-21.

6. Odelin MF, Pozzetto B, Aymard M, Defayolle M, Jolly-Million J: Role of influenza vaccination in the elderly during an epidemic of A/H1N1 virus in 1988-1989: clinical and serological data. Gerontology 1993; 39:109-116.

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